ACA is paying off with access for all

Article by: Editorial Board

Star Tribune

June 13, 2014 - 5:45 PM

The venomous politics dogging the Affordable Care Act and the flawed rollouts of its new health insurance marketplaces have too often overshadowed health reform’s noble goal: ensuring that more Americans have access to vital, potentially lifesaving medical coverage.

But on Wednesday, a groundbreaking analysis released by University of Minnesota researchers offered a powerful reminder of why it’s important to keep the big picture in mind as the challenges of implementing the landmark 2010 law continue. Even though this state struggled with the balky MNsure website, historic gains were made in extending coverage to uninsured Minnesotans as key components of the ACA went into effect last fall and this year.

Before MNsure launched last October, 8.2 percent of Minnesotans did not have health insurance. On May 1, after a major deadline for 2014 coverage had closed on MNsure, the percentage of Minnesotans without coverage fell to 4.9.

Last fall, an estimated 445,000 people in the state were uninsured. By this spring, that number had dropped to 264,500. That’s a 40 percent drop in less than a year.

“I’ve been working on health policy in Minnesota for 17 years. We’ve never had a change of that magnitude happen that fast,’’ said Julie Sonier, one of the lead researchers. The U’s nationally respected State Health Access Data Assistance Center crunched the numbers.

While the state’s mostly Republican critics of the ACA quickly complained that the MNsure website was too costly to build and that the coverage gains came mostly through public programs, the dramatic drop in the uninsured rate is still a milestone.

In eight months, 180,500 people statewide — or about 3 percent of Minnesota’s total population — had been added to the rolls of people with medical coverage. Those who didn’t have insurance, didn’t know how to buy it or couldn’t afford it now have the peace of mind that they have the wherewithal to pay for it.

There’s a moral victory in that. But there’s a real-world benefit for the rest of us, as well. When individuals don’t take responsibility for their care, uncompensated costs are passed on to consumers with private insurance. Taxpayers, who also help pick up these costs, stand to gain, too, when those in public medical programs have better access to preventive care instead of getting expensive emergency care when a crisis occurs.

While MNsure officials were quick to tout the results of the analysis, the website likely played a supporting role rather than the starring role in the coverage gains. What the new Minnesota data indicate is that the ACA’s many strategies to increase insurance coverage are getting results.

While the law is complicated, measures to improve access are straightforward. It provides tax credit subsidies to help low- and middle-income people buy private health insurance. It expands the number of people eligible for medical assistance. It requires Americans to buy health insurance. And it breaks down barriers that prevented people from getting insurance, such as pre-existing conditions.

The much-maligned health insurance exchanges such as MNsure, which help people comparison-shop among plans, are simply a tool to connect people with newly available assistance and allow them to choose the right plan for their families.

MNsure’s critics raised a legitimate point this week when they asked if these gains could have been accomplished without the estimated $155 million in federal dollars awarded to build the MNsure website. They also accurately pointed out that the coverage gains came mainly in public programs such as Medicaid and MinnesotaCare.

MNsure’s cost and the website’s ongoing problems deserve continued scrutiny. The Legislature’s DFL majority clearly preferred playing cheerleader over asking hard questions last session. But perspective is also needed. State policymakers chose to leverage federal dollars available to build MNsure to also take on the daunting task of modernizing the states public assistance eligibility programs and technology. That added to MNsure’s complexity and expense.

As for the public-program enrollment, this shouldn’t have come as a surprise. People without health insurance usually didn’t have it because they couldn’t afford it. That many qualify for public assistance is hardly a news flash. Policymakers also chose to maintain the state’s popular MinnesotaCare program, which provides quality coverage with low monthly premiums for the working poor. Many people who would have bought private coverage in other states, which don’t have something like MinnesotaCare, were eligible for this program instead.

Both the ACA and MNsure remain a work in progress. But the Minnesota analysis, believed to be the first of its kind in the nation, suggests that the hard work of implementing reform is paying off when it comes to a crucial metric we all should care about — making sure our fellow Minnesotans can access the world-class care we are fortunate to have within our borders.